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JAIDS Journal of Acquired Immune Deficiency Syndromes:
doi: 10.1097/QAI.0000000000000306
Original Article: PDF Only

Association of Markers of Hemostasis with Death in HIV-infected Women.

Kiefer, Elizabeth MD, MPH; Hoover, Donald R. PhD, MPH; Shi, Qiuhu PhD; Kuniholm, Mark H. PhD; Augenbraun, Michael MD; Cohen, Mardge MD; Golub, Elizabeth T. PhD, MPH; Kaplan, Robert C. PhD; Liu, Chenglong MD, PhD; Nowicki, Marek PhD; Tien, Phyllis MD, MSc; Tracy, Russell PhD; Anastos, Kathryn MD

Published Ahead-of-Print
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Abstract

In HIV-negatives, markers of hemostasis including D-dimer, Factor VIII, plasminogen activator inhibitor-1 antigen (PAI-1) and total protein S are associated with all-cause and cardiovascular disease mortality. In HIV-positives, studies of D-dimer and Factor VIII with death were limited to short follow-up; associations of PAI-1 and total protein S with death have not been examined.

In 674 HIV-infected women from the Women's Interagency HIV Study (WIHS), markers from the first visit after enrollment were exposures of interest in multivariate analyses of death (AIDS and non-AIDS) in separate models at 5 and 16 years.

There were 87 AIDS and 44 non-AIDS deaths at 5 years, and 159 AIDS and 113 non-AIDS deaths at 16 years. An inverse association of total protein S quartiles with non-AIDS deaths was observed at 5 (p-trend=0.002) and 16 years (p-trend=0.02); there was no association with AIDS deaths. The 3rd quartile of PAI-1 was associated with AIDS deaths at 5 (hazard ratio (HR)=4.0, 95% confidence interval (CI)=1.9-8.4) and 16 years (HR=3.4, 95% CI=1.9-5.9); and with non-AIDS deaths at 5 years (HR=4.8, 95%CI=1.6,13.9). D-dimer and Factor VIII were not associated with AIDS or non-AIDS death at 5 or 16 years.

Lower total Protein S was a consistent marker of non-AIDS death. We found no association between D-dimer with AIDS or non-AIDS death, in contrast to previous studies showing increased short term (<5 years) mortality, which may represent sex differences or population heterogeneity. Given longer survival on HAART, further studies of these markers are needed to determine their prognostic value.

(C) 2014 by Lippincott Williams & Wilkins

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